Second Department of Cardiology, General Hospital of Athens "Evangelismos", Ipsilantou 47, 10676, Athens, Greece.
Department of Cardiology, Helena Venizelou Hospital, Athens, Greece.
Heart Fail Rev. 2018 Jul;23(4):547-553. doi: 10.1007/s10741-018-9689-9.
Although mineralocorticoid antagonists (MRAs) have been proposed as effective fourth-line blood pressure (BP) lowering agents in resistant hypertension, this effect in heart failure is undetermined. In this synthesis of heart failure randomized controlled trials (RCTs), we evaluated the extent of BP lowering following MRA treatment against placebo. We searched Medline and the Cochrane Collaboration Library databases from 1991 to September 2016 for RCTs, in which MRAs were compared with placebo. The quality of RCTs was assessed with Cochrane risk of bias tool. Outcomes were the extent of systolic and diastolic BP lowering. We included seven studies (13,354 patients, 65.8% males, mean age of 66.3 years, mean follow-up period of 9.4 months, mean baseline BP of 123.5/75.0 mmHg) of MRAs compared with placebo. MRAs were not significantly associated with systolic - 1.8 (95% CI: - 8.0, 4.4) mmHg or diastolic - 0.3 (95% CI: - 3.4, 2.7) mmHg, BP reduction. Although systolic BP was not lowered by spironolactone, diastolic BP was lowered by - 3.0 (95% CI: - 3.4, - 2.6) mmHg. Eplerenone treatment did not significantly lowered systolic [- 0.04 (95% CI: - 4.4, 4.3) mmHg], but it was associated with minimal diastolic BP increase [1.0 (95% CI: 0.5, 1.53) mmHg]. MRAs were not associated with systolic and diastolic BP reduction in heart failure patients. This finding suggests that MRAs should be used according to their indications in heart failure independently of initial BP levels.
尽管醛固酮拮抗剂 (MRA) 已被提议作为抗高血压药物中的有效四线降压药物，但在心力衰竭中的疗效尚不确定。在这项心力衰竭随机对照试验 (RCT) 的综合研究中，我们评估了 MRA 治疗相对于安慰剂降低血压的程度。我们从 1991 年至 2016 年 9 月在 Medline 和 Cochrane 协作图书馆数据库中搜索了比较 MRA 与安慰剂的 RCT。使用 Cochrane 偏倚风险工具评估 RCT 的质量。结局是收缩压和舒张压降低的程度。我们纳入了 7 项研究（13354 例患者，65.8%为男性，平均年龄 66.3 岁，平均随访时间为 9.4 个月，平均基线血压为 123.5/75.0mmHg），比较了 MRA 与安慰剂。MRA 与收缩压降低-1.8mmHg（95%CI：-8.0，4.4）或舒张压降低-0.3mmHg（95%CI：-3.4，2.7）无显著相关性。尽管螺内酯未降低收缩压，但降低了舒张压-3.0mmHg（95%CI：-3.4，-2.6）。依普利酮治疗未显著降低收缩压[-0.04mmHg（95%CI：-4.4，4.3）]，但与舒张压轻度升高[1.0mmHg（95%CI：0.5，1.53）]相关。MRA 与心力衰竭患者的收缩压和舒张压降低无关。这一发现表明，MRA 应根据其在心力衰竭中的适应证使用，而不取决于初始血压水平。
